An alternative way of understanding exit, voice and loyalty: the case of informal payments for health care in Israel

Abstract

This study examines Hirschman's model of exit, voice and loyalty with regard to informal payments in the Israeli healthcare system. Based on a national survey, we investigate the extent of "black" payments, its characteristics and its correlated factors. We find that informal payments do exist in Israel-although it seems that there has been a decline in the phenomenon. Contrary to the literature, we find no relationship between the option of voice or dissatisfaction with healthcare services and informal payments. However, we do find a negative correlation between trust and the use of such payments. This finding is consistent with Hirschman's insight that a lack of loyalty may lead people to strategies of exit. We suggest that given the fact that health care in Israel is a public service, the exit option may actually be a quasi-exit behavior. Copyright © 2015 John Wiley & Sons, Ltd.

New insight into the informal patients’ payments on the evidence of literature: a systematic review study

“…Diverse ranges of objectives and scopes, research methods and results have been reported in this regard. A number of these studies have focused on the views and attitudes of patients and service providers toward IPs in health system [13,17,[32][33][34][35][36][37][38][39][40], and a few of them have measured the impact of IPs on the health economy with respect to goals and indicators [41][42][43][44][45]. Several studies have focused on the definitions and methods of studying IPs and systematic reviews in this area [9,[46][47][48] .…”

Alternative provision of public health care: the role of citizens' satisfaction with public services and the social responsibility of government

“…Therefore, it is reasonable to assume that citizens' lack of trust will be related to their perceptions about the health care system and their willingness to make informal payments for health care. Indeed, Filc and Cohen (2015) and Cohen and Filc (2017) has established such a link in Israel.…”

Gaming the system: Responses to dissatisfaction with public services beyond exit and voice

“…First, exit and voice are often linked to expressions of citizenship (Lyons et al 1992), and, in general, the current literature tends to approach the four optional EVLN responses to dissatisfaction as legitimate and consistent with existing provision arrangements. Second, responses to dissatisfaction that exemplify inconsistency with current provision arrangements often refer to the creation and establishment of an alternative supply, which takes place outside the formal supply of the service (Lehman‐Wilzig 1991), and only rarely to behaviours that manipulate existing arrangements (e.g., Cohen and Filc 2017). Third, gaming has been identified as a behaviour of bureaucrats and of targets of regulation; however, it has not been systematically identified as a behaviour of public service clients.…”

“…One prominent example in which gaming and alternative politics overlap is the well‐documented phenomenon of informal payments in healthcare, where alternative politics takes the form of ‘payments to individuals and institutional providers, in kind or in cash, that are made outside official payment channels and purchases that are meant to be covered by the healthcare system’ (Cohen 2012, p. 287, see also Cohen and Filc 2017). Such payments aim at improving the outcome of a healthcare service through, for instance, earlier appointments, obtaining medication unofficially or the ability to choose a doctor.…”